Every day I receive wonderful emails from individuals like you who have heard the Feeling Good Podcasts or read my books or blogs. I just got this amazing email from a fellow named Pete after he listened to the latest podcast on Bibliotherapy. He kindly gave me permission to share it with all of you!
Dear Doctor Burns,
Your book, Feeling Good, has changed my life. After stagnating for two and a half years in three different types of therapy and getting more depressed, I was shown ‘Feeling Good‘ by a social worker. I read on the page exactly what I was doing that created my anger and depression.
I also learnt what perfectionism really was and its negative effects. So I thought… “If I’m doing this to myself, (through my thinking) I’m going to stop doing it.”
That very moment saw the end of my depression, anger and general unhappiness. By removing my cognitive distortions, it was liberating to discover that I was not at the mercy of other people’s behavior. It wasn’t what other people were doing that was affecting me but rather it was my own thoughts!
I feel that I can cope with anything now. I also have recommended this book to many people so David gets the big bucks! A big thanks to David for all his hard work.
What Pete “discovered” is not new–Epictetus said the same thing nearly 2,000 years ago, and it is very basic–but it is SO basic that it’s hard to “get” at first. When you suddenly comprehend this notion, that we are all creating our own emotional reality at every moment of every day, you can experience enlightenment. It’s not just feeling a bit less depressed, but a transforming and remarkable experience that’s available to all of us!
One small warning. The Buddha said that we all drift in and out of enlightenment. This means that the negative distorted thoughts WILL return, for all of us! That’s why Relapse Prevention Training is so important.
To learn more about any topic, you can use the search function in the right-hand panel of every page on my website. You’ll really like it!
David Burns, MD
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Hi podcast fans,David and Rhonda discuss and old controversy: Can a self-help book can really help? Or will you need psychotherapy and / or an antidepressant if you are seriously depressed?
I (DB) wrote up the following overview of bibliotherapy research prior to today’s recording with Rhonda. I hope you find it interesting!
I have to admit that I’ve never had much respect for self-help books. Many of them seem to be written by narcissistic individuals with pretty superficial ideas who mainly want to promote themselves, and this has been my strong bias as well. When I pick one up in a bookstore, I nearly always get immediately turned off. And I get a flood of them in the mail as well, from authors asking for an endorsement. I have a policy of not doing book or product endorsements—it’s the easiest way to say no.
And I never thought of my book, Feeling Good: The new Mood Therapy, as a self-help book. My idea was that people receiving cognitive therapy could read it between sessions as a way of speeding up their recovery, so that the therapist could do the individual work and not have to do so much teaching about the basic concepts, like my list of ten cognitive distortions.
But at the same time, shortly after the book was released, I began getting letters, and later on emails, from individuals who said they book had actually caused them to recover from pretty severe depression. In fact, over the years, I would guess I’ve received more than ten thousand letters or emails like that, and probably way more than that, maybe even fifty thousand.
Still, it had not occurred to me that it might actually be a self-help book, in spite of the fact that lots of the people who wrote me said the book had helped them much more than the treatments they’d received over the years.
One day a colleague asked if I’d seen the article about my book in the New York Times. Apparently, Dr. Forrest Scogin, a research psychologist from the University of Alabama Medical Center, had studied the effects of reading a self-help book on patients seeking treatment for moderate to severe depression. In a nutshell, their studies indicated that simply reading Feeling Good may help some patients overcome depression and may help to prevent future relapses as well. This finding was a shock, but was not entirely unexpected due to all the testimonials I’d been received from people who’d read the book.
In their first study, Dr. Forest Scogin and his colleagues told patients seeking treatment for depression that they’d be placed on a four-week waiting list before beginning treatment. Half of the patients were given a copy of either my Feeling Good or a self-help book on depression by Dr. Peter Lewinsohn called Up from Depression. The researchers suggested that the patients could read their book while they were waiting for their first appointment with the psychiatrist.
The other half of the patients who were placed on the four-week waiting list did not receive a copy a self-help book. Both groups of patients were contacted each week by a research assistant who administered a test to assess the severity of depression. The goal of course was to find out if there were any changes in depression in any of the patients.
The results of the study were interesting. Approximately two-thirds of the patients who received one of the self-help books improved or recovered from depression during the four weeks, even though they received no other treatment with drugs or psychotherapy. In fact, they improved to such an extent that most of them did not even need any further treatment. In contrast, the patients who did not receive one of the books failed to improve during the four-week waiting period. As far as I know, this was the first time that the anti-depressant effects of a self-help book had ever been documented in carefully controlled research study published in a scientific journal.
Then the researchers did a number of additional experiments. First, they gave a copy of one of the two self-help books to the patients in the second group who had not improved. They asked them to wait four more weeks before beginning treatment, but suggested they read the book during their wait. Two-thirds of them also improved and did not need further treatment. This study was published in the medical journal, Gerontologist.
Some critics challenged the study, arguing that the improvement in the patients who received the self-help book might have simply been a placebo effect. In other words, maybe it was just the reading, and the expectation of recovery, that helped, as opposed to the ideas and techniques described in the books.
To test this, the investigators studied a new group of patients who were asked to read a “placebo” book while waiting for treatment. The researchers chose a classic book by Victor Frankl called Man’s Search for Meaning. If these patients also improved, it would confirm that the effect of reading on mood was simply a non-specific “placebo” effect. This is incredibly important, because almost any type of intervention can have a placebo effect, so that as many as 35% of patients will improve just because they think they’ll improve.
Surprisingly, the patients who read the Victor Frankl book did not improve. This exciting finding indicated that a self-help book can have a specific and fairly strong antidepressant effect, but that the book had to contain sound information that was actually helpful to individuals with depression.
Finally, the investigators also did several careful follow-up studies on these patients to find out if the antidepressant effects of Feeling Good and Up from Depression would last. In several additional publications, they reported that these patients did not relapse but maintained their improved moods for periods up to three years, and that they actually continued to improve following their initial Feeling Good “bibliotherapy.
However, they did not report that they were happy all the time. But when they hit bumps in the road, most of them picked up the book again, and re-read the sections that had been the most helpful, and then quickly recovered again.
It’s great that two thirds of the patients improved so rapidly. This result is at least as good as the effects of antidepressants or treatment with psychotherapy—and it’s far cheaper, and with no side effects either! But at the same time, one third of the patients did NOT improve. And of course, you see the same thing with treatment of depression by a psychiatrist or psychologist. In fact, recent research indicates that only 50% of patients, AT MOST, improve with professional treatment.
In my research, I’ve attempted to figure out what’s different about the patients who do not rapidly recover when treated with psychotherapy or Feeling Good bibliotherapy. And I believe I did find out why. To learn about that, you’ll have to listen to the Feeling Good Podcasts or read my new book, Feeling Great, when it comes out. Hopefully fairly soon!
I was pretty inspired by the terrific and important research by Forrest Scogin, and want to thank him!
If you or your patients would like to read one of my “self-help” books, the following table will show you which books are best for which kinds of problems. The reading list at the end is for individuals who might like to check out the original studies by Dr. Scogin and his colleagues.
This is a simplified ten-step program to overcome depression and boost self-esteem. it is effective individually or in support groups.
Ackerson J, Scogin F, McKendree-Smith N, Lyman RD (1998) Cognitive bibliotherapy for mild and moderate adolescent depressive symptomatology. J Consult Clin Psychol 66: 685-690.
Floyd M, Rohen N, Shackelford JA, Hubbard KL, Parnell MB, et al. (2006) Two-year follow-up of bibliotherapy and individual cognitive therapy for depressed older adults. Behav Modif 30: 281-294.
Floyd M, Scogin F, McKendree-Smith N, Floyd DL, Rokke PD (2004) Cognitive therapy for depression: a comparison of individual psychotherapy and bibliotherapy for depressed older adults. Behav Modif 28: 297-318.
Jamison C, Scogin F (1995) The outcome of cognitive bibliotherapy with depressed adults. J Consult Clin Psychol 63: 644-650.
Mains JA, Scogin FR (2003) The effectiveness of self-administered treatments: a practice-friendly review of the research. J Clin Psychol 59: 237-246.
McKendree-Smith NL, Floyd M, Scogin FR (2003) Self-administered treatments for depression: a review. J Clin Psychol 59: 275-288.
Scogin F, Floyd M, Jamison C, Ackerson J, Landreville P, et al. (1996) Negative outcomes: what is the evidence on self-administered treatments? J Consult Clin Psychol 64: 1086-1089.
Scogin F, Hamblin D, Beutler L (1987) Bibliotherapy for depressed older adults: a self-help alternative. Gerontologist 27: 383-387.
Scogin F, Jamison C, Davis N (1990) Two-year follow-up of bibliotherapy for depression in older adults. J Consult Clin Psychol 58: 665-667.
Scogin F, Jamison C, Gochneaur K (1989) Comparative efficacy of cognitive and behavioral bibliotherapy for mildly and moderately depressed older adults. J Consult Clin Psychol 57: 403-407.
Smith NM, Floyd MR, Jamison CS, and Scogin F (1997) Three-year follow-up of bibliotherapy for depression. J Consult Clin Psychol 65: 324-327.
You can reach Dr. Burns at email@example.com. Dr. Rhonda Barovsky practices in Walnut Creek, California, and can be reached at firstname.lastname@example.org.
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Dr. Jill Levitt and I are offering what I think will be an outstanding workshop on the treatment of anxiety disorders on Sunday, May 19, 2019. Our Sunday workshops can be tremendously rewarding, so consider attending if you are interested.
The last Sunday workshop in February was really fun! We have been SOLD OUT for the in person slots in Palo Alto for two months, but still have spots online, and you can join us from anywhere in the world. Register soon if you are interested, as the online slots are also limited.
THERE WILL BE MANY EXPERT TRAINERS TO GUIDE THE ONLINE PARTICIPANTS DURING THE SMALL GROUP EXERCISES
WHEN: May 19, 2019, 8:30 am – 4:30 pm PST (11:30 am-7:30 pm EST)
WHERE: Join us live online or in person at the Creekside Inn, Palo Alto, CA.
HOW MUCH DOES IT COST? $135,
WILL I GET CE CREDITS? YES! 7 CE hours available
WILL I GET CREDIT IN THE TEAM LICENSURE PROGRAM? YES! Completion of this workshop also counts towards TEAM-CBT Level 1, 2 or 3 Certification
WHO CAN ATTEND? Therapists of all levels are welcome
CAN I REGISTER IF I’M NOT A THERAPIST? Although the workshop is geared for therapists, it will be taught in a clear and basic way that anyone can benefit from.
WILL I HAVE FUN? Yes!
WILL I HAVE GET TO HANG OUT WITH SOME COOL COLLEAGUES? Yes!
WILL I GET AN AWESOME FREE BREAKFAST AND LUNCH? Yes!
You will love this lively, amusing, and immensely useful day of training with Drs. Burns, Levitt and the Feeling Good Institute Staff. The trainers will use a combination of didactic teaching, live demonstrations, video, and breakout group practice to enhance skill-building.
I suffer from social anxiety and depression. I feel that I don’t need to see a therapist and believe that CBT will be enough to help me.
I have purchased three of your books: The Feeling Good Handbook, Ten Days to Self Esteem and Intimate Connections. This might be overkill but I really wanted to cover all the bases.
However now I am confused and don’t know where to start and how to manage the learning. Which book should I work on first and how long do you think it should take to work through any given book? I believe somewhere you suggest that the Feeling Good Handbook this should be completed within 30 days. Any advice would be much appreciated.
Dr. David’s Answer
Thank you for your question. There are no rules of the road. Ten Days to Self Esteem is the shortest and easiest book, with exercises you can complete at each of the 10 steps. Essentially, it is a 10-step program to teach you the basics of CBT and to show you how to boost your own self-esteem. The publisher has insisted on the name, Ten Days to Self Esteem, but I would prefer the name, Ten Steps to Self-Esteem, so you can complete it at your own pace.
Intimate Connections can be very helpful for loneliness and shyness–it is about the power dynamics of dating to some extent, and how to communicate, how to flirt, how to get people to chase you, how to deal with rejection, and so forth. It also shows you how to overcome the fear of being alone. It is somewhat autobiographical, too, since these are issues I struggled with when I was growing up.
The Feeling Good Handbook is a strong book with a focus on depression as well as anxiety, including shyness, and relationship conflicts as well.
I would start with any one of them and focus on it. There is considerable overlap, so once you learn the techniques they will all flow very easily for you. The key is doing the exercises while you read. The people who do the exercises are almost always the ones who benefit the most from any of my books.
It is kind of like riding a bicycle. You can’t learn to ride by reading about bicycles or watching people ride bicycles. You’ve got to get on a bicycle and give it a try. It might feel a bit shaky, or new and unfamiliar at first, but you can quickly learn to ride.
Research studies have shown that many people can use these books without a therapist and benefit tremendously. Some people with more severe or long-standing will also need the help of a skillful and compassionate therapist, of course.
I am now working on something new and extremely exciting, and will announce it as soon as possible on this website.
Just a quick note to wish you well and to thank you again for your best seller and “best helper” for guys like me who have benefited from it. The last I saw something about your research you had concentrated somewhat on the part motivation plays and how it may be as important as other areas . . . maybe even more so.
Also, I was wondering what your latest book was so I can get it, and if you were planning another one soon?
In closing, let me say I have no idea how many thousands you have helped with one mood disorder or another – I only know of one personally…that would be me, and I will be forever grateful. Your friendly writing style enabled me to feel like we were friends after the first few chapters of “Feeling Good” and I still read it when a “booster” session is called for.
Thanks again and “feeling good!”
I greatly appreciate your comment! It means a lot to me! And I’m so happy that you have benefitted from reading Feeling Good. If you are not yet aware of my free weekly Feeling Good podcasts, you might enjoy them. They are available on iTunes and also right here on my website in the blog tab.
New book? I kind of feel like I’m pregnant right now, and a new book wants to come out as I now have tons of new stuff, both ideas and techniques with tremendous healing potential. But I kind of need a title, or a concept for a title. Any ideas? Let me know if anything comes to mind.
I had thought of revising Feeling Good, but when I looked at it (for the first time in years), I realized I did not want to disturb it, as it works really well as is for so many folks. And my “voice” now is quite different—although friendly is still important, for sure!
Thanks again for your thoughtfulness.
Website visitors–any title suggestions if I do a new book? Any guidance would be appreciated!